Forth Worth Surgical Associates PA

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

G8340 Issued in TX

Legal business name

FORTH WORTH SURGICAL ASSOCIATES PA

Practice address

6100 Harris Pkwy
#390
Fort Worth, TX 76132-4128

Phone

(817) 370-9011

Fax

(817) 346-0380

NPI assigned

Oct 12, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

William Robert Pettey, MD

Title

Owner

Phone

(817) 370-9011

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1129075200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196208000000",
    "number": "1679561641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6100 HARRIS PKWY",
            "address_2": "#390",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761324128",
            "telephone_number": "817-370-9011",
            "fax_number": "817-346-0380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6100 HARRIS PKWY",
            "address_2": "#390",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761324128",
            "telephone_number": "817-370-9011",
            "fax_number": "817-346-0380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORTH WORTH SURGICAL ASSOCIATES PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-12",
        "last_updated": "2007-11-28",
        "status": "A",
        "authorized_official_last_name": "PETTEY",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "817-370-9011",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "TX",
            "license": "G8340",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP",
            "identifier": "91159",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4254295",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Surgery Physician in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Surgery Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.